Biomedical subjects

Gilles Poissonnet

Publications and source records attributed to Gilles Poissonnet.

6 recordsLinked to original sources

PubMed2006

[Parathyroid carcinoma].

Parathyroid carcinoma is a rare disease accounting for 1 to 5% of parathyroid neoplasms. This malignant tumour must be suspected when a severe primary hyperparathyroidism occurs with high hypercalcemia and elevated parathormon levels. At this time, a cervical mass is often palpable. Both head and neck ultrasonography and 99mTc-sestamibi scintigraphy are the best preoperative imaging tests to suspect and localize the tumour. Surgical approach with simultaneous tumorectomy and hemithyroidectomy, completed by selective neck dissection (level VI) is the treatment of choice. An elective lateral neck dissection should be performed if necessary. Tumour control should be monitored by regular measurement of calcium and parathormon levels. Local recurrence or metastasis risk is 30 to 70% and the 5 year overall survival about 50 to 80%. In case of recurrence, aggressive surgical management should be applied and adjuvant radiation therapy may be discussed.

Humans↗

PubMed2006

French multicenter phase III randomized study testing concurrent twice-a-day radiotherapy and cisplatin/5-fluorouracil chemotherapy (BiRCF) in unresectable pharyngeal carcinoma: Results at 2 years (FNCLCC-GORTEC).

BACKGROUND: Unresectable carcinomas of the oropharynx and hypopharynx still have a poor long-term prognosis. Following a previous phase II study, this phase III multicenter trial was conducted between November 1997 and March 2002. METHODS: Nontreated, strictly unresectable cases were eligible. Twice-daily radiation: two fractions of 1.2 Gy/day, 5 days per week, with no split (D1-->D46). Total tumor doses: 80.4 Gy/46 day (oropharynx), 75.6 Gy/44 day (hypopharynx). Chemotherapy (arm B): Cisplatin 100 mg/m2 (D1, D22, D43); 5FU, continuous infusion (D1-->D5), 750 mg/m2/day cycle 1; 430 mg/m2/day cycles 2 and 3. RESULTS: A total of 163 evaluable patients. Grade 3-4 acute mucositis 82.6% arm B/69.5% arm A (NS); Grade 3-4 neutropenia 33.3% arm B/2.4% arm A (p < 0.05). Enteral nutrition through gastrostomy tube was more frequent in arm B before treatment and at 6 months (p < 0.01). At 24 months, overall survival (OS), disease-free survival (DFS), and specific survival (SS) were significantly better in arm B. OS: 37.8% arm B vs. 20.1% arm A (p = 0.038); DFS: 48.2% vs. 25.2% (p = 0.002); SS: 44.5% vs. 30.2% (p = 0.021). No significant difference between the two arms in the amount of side effects at 1 and 2 years. CONCLUSION: For these unresectable cases, chemoradiation provides better outcome than radiation alone, even with an "aggressive" dose-intensity radiotherapy schedule.

Adult↗

PubMed2006

[Radiation-induced mucositis of the aerodigestive tract: prevention and treatment. MASCC/ISOO mucositis group's recommendations].

Acute mucositis is the main intensity-limiting toxicity in the management of head and neck (H&N) and digestive track carcinomas with radiotherapy. New radiation modalities (hyperfractionation and/or acceleration) as well as combined modality regimens in this situation induce higher rates of acute toxicity. Hyperfractionation for example allows higher control rates, with few late toxicities, but it slightly increases acute mucositis. The addition of chemotherapy introduces systemic toxicity and can exacerbate local tissue reactions when used concurrently with radiation. Mucositis is recognized as the principal limiting factor to further treatment intensification. As local-regional control and overall survival are related to dose-intensity in this case, further research into the assessment, analysis, prevention and treatment of mucosal toxicity is not only crucial to the improvement in quality of life, but certainly to improved rates of disease control as well. Several topical and systemic treatments are directed to the decrease and the acceptance of this acute toxicity, but few have shown significant preventive effect. Improvement of technical aspects of H&N radiotherapy (3D conformal radiation, intensity-modulated radiotherapy) should have a major impact in the prevention of mucositis. The efficacy of low level laser therapy in the management of such a toxicity could hence yield important development of this method in the field of oncology. MASCC/ISOO mucositis group's recommendations for the management of acute radiation-induced mucositis are here summarized.

Digestive System Diseases↗

PubMed2005

Prognostic impact of the epidermal growth factor receptor levels for patients with larynx and hypopharynx cancer.

The aim of this study was to analyse prognostic factors for disease free interval (DFI) and overall survival (OS) among patients with larynx and hypopharynx cancer requiring a total laryngectomy. Three groups of patients were studied according to the type of treatment they received. Fifty-eight patients had total laryngectomy, 71 patients had organ preservation treatment including induction chemotherapy followed by exclusive radiotherapy, 26 patients received induction chemotherapy followed by salvage total laryngectomy. The studied potential prognostic factors were age, gender, performans status, primary tumor localization, T status, N status, tumor volume and tumoral EGFR level (fmol/mg protein). The multivariate analysis showed that both N status and tumor volume were significant for DFI and OS. EGFR level was significant only for patients treated by induction chemotherapy and exclusive radiotherapy (p = 0.05 and 0.05 for DFI and OS length, respectively). Among this group, patients with tumor EGFR levels lower and higher than 100 fmol/mg protein had 53% versus 22% and 51% versus 18% 5-year of DFI and OS rates, respectively (Log rank test: p = 0.001 and 0.0001). EGFR determination appears to be a powerful prognostic parameter for patients treated by induction chemotherapy followed by exclusive radiotherapy. Laryngectomy seems to erase the prognostic impact of EGFR expression. These results profile the use of EGFR targeting therapy for this category of patients.

Adult↗

PubMed2004

Is routine triple endoscopy for head and neck carcinoma patients necessary in light of a negative chest computed tomography scan?

BACKGROUND: The objective of the current study was to analyze the results obtained by triple endoscopy during the initial evaluation of a primary carcinoma of the head and neck. METHODS: A total of 487 patients with a squamous cell carcinoma of the head and neck was studied. None of the patients had evidence of metastasis or a second primary tumor on the thoracic computed tomography (CT) scan or chest X-ray. All patients underwent a triple endoscopy including nasopharyngoscopy, laryngoscopy, pharyngoscopy, bronchoscopy, and esophagoscopy. RESULTS: A synchronous primary invasive carcinoma of the lung and esophagus was diagnosed in 5 patients (1%) and 10 patients (2%), respectively. In addition, nine lesions were considered to be a regional extension of the primary tumor to the esophagus, and nine in situ carcinomas were observed. It is interesting to note that a significant correlation was found between the risk of a second synchronous esophageal carcinoma and the initial location of the primary head and neck carcinoma (P = 0.002, chi-square test). Esophageal carcinoma was observed in 1.3% of the patients with an oropharyngeal tumor, 2% of the patients with a laryngeal tumor, none of the patients with a tumor of the oral cavity, and 9.2% of the patients with a hypopharyngeal tumor. CONCLUSIONS: The role of bronchoscopy and esophagoscopy in the presence of a normal thoracic CT scan has been questioned because of the relatively low incidence of a second esophageal and/or lung primary tumor. Nonetheless, based on the same incidence criterion, it appears reasonable to schedule a routine esophagoscopy for those patients with a squamous cell carcinoma of the hypopharynx.

Adult↗

PubMed2003

T1-T2 NO oropharyngeal cancers treated with surgery alone. A GETTEC study.

The aim of this study is to show that surgical treatment of early-stage squamous cell carcinomas of the oropharynx gives identical, if not better, oncological results than the classic radiotherapy treatment in terms of locoregional control and survival. Fifty-three patients (32 T1, 21 T2, all N0) were operated on during the years 1995-2000. Surgical treatment consisted in a resection by the transoral approach in 43 patients (81.13%); ten patients (18.87%) benefited from a pharyngectomy with (seven) or without (three) mandibular resection. A level I to V selective neck dissection was performed on 35 patients, and 5 patients underwent a level II to V selective neck dissection. The 1-, 3- and 5-year overall survival rates were 100, 94.6 and 73%, respectively. There was no significant difference concerning the tumor stage ( P=0.69), the initial localization ( P=0.64), the macroscopic aspect ( P=0.65) and the management undertaken in the different centers ( P=0.19). The 5-year rate of specific survival was 100%. The 1-, 3- and 5-year locoregional control rates were 96.22, 92.45 and 88.68, respectively. The oncological occurrences observed were 2 persistent diseases, 5 local recurrences, 11 second primary cancers and 0 nodal recurrences. Seven local failures were observed, all of which were controlled after a second treatment. Eleven patients presented second primary cancers; three died, two are alive with an extension of this second localization, and six are alive and free of disease. The locoregional control provided by surgery alone on T1-T2 N0 oropharyngeal cancers is as good as radiotherapy. Moreover surgery alone makes it possible to spare patients the complications and aftereffects of radiotherapy. It also makes it possible during the recurrences to operate on patients in non-irradiated areas with lower morbidity and mortality. It is all the more beneficial since it will be possible to resort to radiotherapy after surgery if need be.

Carcinoma, Squamous Cell↗